The Economics of Tobacco and Tobacco Control

Chapter 2: Patterns of Tobacco Use, Exposure, and Health Consequences
There is concern that the introduction of new ST products and their marketing to new users may lead to
increased tobacco use in countries or populations where it had previously been low. In some HICs,
cigarette manufacturers have introduced ST products with attractive flavorings, such as mint or fruit
flavors, and new nicotine delivery methods, such as lozenges or small pouches that allow for more
concealed use. For example, sales of moist snuff products (including snus) in the United States increased
65.6% between 2005 and 2011. 20
Table 2.10
Prevalence of Adult Current Smokeless Tobacco Use, by WHO Region and Country Income
Group, 2010
Estimated prevalence (%)
Number of ST users (in millions)
WHO Region
Men Women Both sexes Men Women Both sexes
Global 8.4 4.6 6.5 223.3 122.7 346.0
African 2.8 2.1 2.4 7.6 5.9 13.4
Americas 0.6 0.2 0.4 1.3 0.5 1.8
Eastern Mediterranean 4.1 1.4 2.9 9.0 2.8 11.8
European 2.1 0.1 1.0 3.4 0.2 3.6
South-East Asia 27.4 16.5 22.0 187.3 109.6 296.9
Western Pacific 1.0 0.4 0.7 6.5 2.8 9.2
High-income OECD 1.9 0.2 1.2 8.2 1.0 9.2
World Bank country
income group
Estimated prevalence (%)
Number of ST users (in millions)
Men Women Both sexes Men Women Both sexes
Global 8.4 4.6 6.5 223.3 122.7 346.0
High-income 1.7 0.2 1.1 8.9 1.2 10.1
Upper middle-income 1.0 0.5 0.7 9.4 4.5 13.8
Lower middle-income 19.0 10.2 14.6 171.7 90.7 262.3
Low-income 12.7 9.8 11.2 33.3 26.4 59.7
Notes: WHO = World Health Organization. ST = smokeless tobacco. High-income OECD countries = countries defined as high-income by the
Organisation for Economic Co-operation and Development. High-income OECD countries are excluded from their respective regions. Country income
group classification based on World Bank Analytical Classifications for 2014.
Source: Based on data from World Health Organization 2015. 1 For more information, see the Statistical Annex.
Prevalence of Smokeless Tobacco Use Among Youth
Using data from the Global Youth Tobacco Surveys, WHO has estimated that at least 12.8 million
youth ages 13–15 globally used ST in 2010, a prevalence of 3.6% (Table 2.11). This compares with a
prevalence rate of 7.0% for youth cigarette smoking (24.8 million youth). The number of boys using
ST was 8.6 million compared with 4.2 million girls, for a ratio of 2 boy users for every girl user. These
prevalence rates and absolute numbers of users were derived by applying prevalence data for surveys
carried out between 2007 and 2014 to the 2010 regional and global 13- to 15-year-old populations
(as estimated by the UN Population Division). 5
52